Abstract
Epidural blockade in children has become more popular for postoperative analgesia in recent years owing to increased experience, greater confidence and the development of appropriate equipment. In the UK, about 2000 lumbar epidural and continuous caudal blocks are performed each year. Spinal anaesthesia remains popular for babies at risk of postoperative apnoea, but is increasingly being superseded by light general anaesthesia with desflurane or sevoflurane combined with caudal blockade, which produces more rapid recovery from anaesthesia. Contraindications to neuraxial blockade are the same as for adults (patient or parental refusal, coagulation abnormalities, septicaemia, raised intracranial pressure, meningitis, infection at the entry site, allergy to local anaesthetics) but also include myelomeningocele (spina bifida) and, for a caudal epidural, abnormal sacral anatomy.
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